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  1. S/Sx of hypothyroidism
    • Dec metabolic rate
    • Bobby Hill
    • Can be due to low iodine in diet
    • Or can be idiopathic
  2. Autoimmune Hypothyroidism
  3. Treatment for hypothyroidism
    T4 - Levothyroxine
  4. T4 converts to
  5. Considerations when giving Levothyroxine
    • Accelerates degredation of Vitamin K
    • So you may need to lower warfarin doses
  6. T3
  7. Consideration for Liothyronine
    Short half life
  8. Graves/Plummers Disease
  9. S/Sx of hyperthyroidism
    • increased metabolic rate
    • exopthalamus (Graves only)
  10. Treatment for hyperthyroidism
    Oral glucocorticoids
  11. Treatment for hyperthyroidism
    • Propylthiouracil
    • Methimazole
  12. Propylthiouracil and Methimazole action
    Blocks T3/T4 production
  13. Treatment plan for Propylthiouracil and Methimazole
    Give for 6 months to 2 years, then check T3/T4 levels
  14. Propylthiouracil and Methimazole are used in conjunction with what to treat symptoms of hyperthyroidism
    Beta blockers
  15. Take a CBC for patients taking Propylthiouracil or Methimazole to check for
    agranulocytosis, check for WBC count being too low
  16. Lack of Iodine leads to
    • Increased TRH and TSH release
    • Thyroid will increase in size (goiter)
  17. High levels of Iodine
    • Decrease in iodine uptake
    • Synthesis and release of T3/T4 is suppressed
  18. Treatment for Thyroid Storm
    Potassium Iodine or Iodine Salts
  19. Hyperthyroid treatment for a MALIGNANT tumor
    Iodine 131 - a radioactive iodine taken up by the thyroid
  20. GH is stimulated by
  21. GH is inhibited by
    • Hyperglycemia
    • Cortisol
  22. somatoSTATIN is the hormone that inhibits GH release from the AP
    somatoTROPIN is the drug that is given to somebody with a GH deficiency (dwarfism)
  23. GH causes hyperglycemia
    So GH supplement (somatoTROPIN) will be diabetagenic (causes hyperglycemia)
  24. Acromegally Tx (drugs)
    • Sandostatin - analogue of  somatoSTATIN
    • Alternative is Somavert
  25. Drug Tx for diabetes Insipidus
    DDAVP (Demopressin)
  26. Arganine Vasopressin
    Synthetic ADH
  27. Arganine Vasopressin will have what effect on B/P
    Increase, it is a vasoconstrictor
  28. Other uses for Arganine Vasopressin
    • GI bleeds (contracts smooth muscle)
    • Systemic shock or cardiac arrest (causes vasoconstriction)
  29. Role of PTH
    • Activates vitamin D
    • Promotes reabsorption of Ca+ from the bone
  30. Vitamin D effect on Ca+
    Promotes Ca+ reabsorption from the bones
  31. What two organs must be active for Vitamin D to be activated?
    • Liver
    • Kidneys
    • Sunlight must convert Vitamin D
  32. Calcitonin - opposite of Vitamin D
    • Secreted by the Thyroid
    • Inhibits reabsorption of Ca+ from the bones
  33. Tx for hypercalcemia
    • Use normal saline to increase urinary excretion
    • Can also use a loop diuretic
  34. Hypocalcemia Tx
    Ca+ supplementation and Vitamin D
  35. Osteoporosis Tx
  36. Major adverse effect from Fosamax use
  37. SERMs
    Select Estrogen Receptor Modulators
  38. SERMs action
    Acts as Estrogen, preserves bone density
  39. Side effect of SERMs
    Pro-coagulant - look for DVT
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